School of Pharmacy, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand.
Patient. 2021 Sep;14(5):505-532. doi: 10.1007/s40271-020-00488-7. Epub 2020 Dec 18.
Optimal care of rheumatoid arthritis (RA) patients entails regular assessment of disease activity and appropriate adjustment of disease-modifying antirheumatic drugs (DMARDs) until a predefined treatment goal is achieved. This raises questions about the approach to treatment decision making among RA patients and their preference for associated treatment changes. We aimed to systematically identify and synthesize the available evidence of RA patients' preferences regarding DMARD modification with an emphasis on escalating, tapering, stopping, or switching of DMARDs.
A scoping review was undertaken to gauge the breadth of evidence from the range of studies relating to RA patients' preferences for DMARD modification. Pertinent databases were searched for relevant studies published between 1988 and 2019. Conventional content analysis was applied to generate themes about how patients perceive changes to their RA treatment.
Of the 1730 distinct articles identified, 32 were included for review. Eight studies investigated RA patients' perceptions of switching to other DMARDs, 18 studies reported RA patients' preferences for escalating treatment, and six studies explored the possibility of tapering or stopping of biologic DMARDs. Four overarching themes relating to RA patients' preferences for treatment modification were identified: (i) patient satisfaction, (ii) patients' beliefs, (iii) information needs, and (iv) patient-clinician relationships.
Uptake of treatment changes in clinical practice can be improved by understanding how RA patients approach the decision to modify their treatment and how this relates to their satisfaction, beliefs, information needs, and relationships with clinicians. Future work is needed to systematically determine the significance of these factors in RA patients' decision-making processes.
类风湿关节炎（RA）患者的最佳治疗需要定期评估疾病活动度，并适当调整疾病修饰抗风湿药物（DMARDs），直到达到预设的治疗目标。这就提出了关于 RA 患者治疗决策方法的问题，以及他们对相关治疗变化的偏好。我们旨在系统地识别和综合现有关于 RA 患者对 DMARD 调整偏好的证据，重点关注 DMARD 的升级、降级、停药或换药。
进行了范围综述，以评估与 RA 患者对 DMARD 调整偏好相关的研究范围的证据广度。搜索了相关数据库，以获取 1988 年至 2019 年期间发表的相关研究。应用常规内容分析生成关于患者如何看待 RA 治疗变化的主题。
在 1730 篇不同的文章中，有 32 篇被纳入审查。有 8 项研究调查了 RA 患者对改用其他 DMARD 的看法，18 项研究报告了 RA 患者对升级治疗的偏好，6 项研究探讨了生物 DMARD 停药或减量的可能性。确定了与 RA 患者对治疗调整偏好相关的四个总体主题：（i）患者满意度，（ii）患者信念，（iii）信息需求，以及（iv）医患关系。
通过了解 RA 患者如何对待改变治疗的决定，以及这与他们的满意度、信念、信息需求和与医生的关系如何相关，可以改善临床实践中治疗变化的采用。需要进一步的工作来系统地确定这些因素在 RA 患者决策过程中的重要性。
